Care Home: Talbot View

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What the care home does well People`s needs are assessed before they move into the home. There are good quality, easy to read care plans in place. People have good access to local District Nurses, General Practitioners and specialist health care when required. Visitors are made welcome and people are encouraged to maintain contact with family and friends. People enjoy the food provided by the home. People and their families know how to complain or raise their concerns about the home. The home is well maintained and designed with the people living there in mind. Staff employed by the home undergo an induction programme and there is an active NVQ (National Vocational Qualifications) programme. What has improved since the last inspection? Care plans are now reviewed regularly on a monthly basis to accurately reflect any changes in care needs for a person. Care plans are written following clinical guidelines available for specific health needs, such as epilepsy. Appropriate actions are identified regarding protecting people at risk of developing pressure areas. The home is aware of adjusting staffing levels to ensure people`s needs continue to be safely met and regularly review this. The home has a manager in place who is now registered with the Care Quality Commission. Fire safety checks are carried out as required. What the care home could do better: Care plans generally are detailed and show staff how to meet individual`s needs. However improvements should be made to ensure that care plans reflect peoples` current needs. Daily records should be further improved to ensure that these give a more accurate reflection of people`s day to day lives rather than the care and support provided to them. All staff should receive regular updates in safeguarding training to ensure that people living there are properly protected from the risk of harm or neglect. Staff must receive training and regular updates appropriate for the work and care they provide. Key inspection report Care homes for older people Name: Address: Talbot View 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Talbot View 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG 01202537571 01202547328 talbotview@care-south.co.uk www.care-south.co.uk Care South Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Nicholas Robin Holman Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: One service user (name known to CSCI) in the category of LD(E) may be accommodated. Three service users (names known to the CSCI) in the category LD may be accommodated. Two service user (names known to CSCI) in the category of DE may be accommodated. Date of last inspection Brief description of the care home Talbot View is part of the Care South group of homes. Care South is a non-profit making organisation. Talbot View provides accommodation for a maximum of 59 older people who require personal assistance due to old age and frailty and or dementia type Care Homes for Older People Page 4 of 29 0 5 0 1 2 0 0 9 0 0 Over 65 43 16 Brief description of the care home illnesses. The premises were purpose built in 2000 and provide accommodation in 59 single rooms, all with en-suite facilities on ground and first floor levels. The first floor is reached by a passenger lift or one of three stairways. Accommodation is arranged in four houses; Warehams Way, Lollipop Lane and Butlers Brook provide 43 beds which are registered to accommodate people with dementia care needs, Highmoor Heath accommodates older people with general personal care needs. All dementia care houses have keypad entry systems to ensure residents safety. Each house provides single room accommodation and shared, communal areas consisting of lounge and dining room areas. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The purpose of this inspection was to assess all of the key standards and improvements made since the last key inspection. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The manager supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgements about the service, and have been included in this report. This unannounced inspection was carried out over one day by two inspectors. The term we is used throughout the report to reflect the findings of the Care Quality Commission. Care Homes for Older People Page 6 of 29 The visit took place on 11 January between 10am and 4pm. The manager was present throughout the inspection. The inspection involved observations of and talking with people who live or were staying at the home, the staff on duty and the manager. Five people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care plans generally are detailed and show staff how to meet individuals needs. However improvements should be made to ensure that care plans reflect peoples current needs. Daily records should be further improved to ensure that these give a more accurate reflection of peoples day to day lives rather than the care and support provided to them. All staff should receive regular updates in safeguarding training to ensure that people Care Homes for Older People Page 8 of 29 living there are properly protected from the risk of harm or neglect. Staff must receive training and regular updates appropriate for the work and care they provide. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into or staying at the home benefit from having their care needs assessed, so that they can be sure the home can meet their needs. Evidence: The statement of purpose and service user guide is clear and detailed and gives information about what needs the home can meet. A trial period of stay is also offered to ensure that the home and the individual are both happy that needs can be met. An up to date certificate of registration is on display in the entrance. The manager or deputy manager undertakes a pre admission assessment before determining whether they can meet someones needs. A fuller assessment, risk assessments and a social history assessment are completed with people as soon as they move in. From this a care plan is developed. Care Homes for Older People Page 11 of 29 Evidence: The assessments for two people who had recently moved to Talbot View were seen. They were clear and personalised and showed where the information had come from, such as other health care professionals. The AQAA submitted by the home says Following an admission there is a 6 week assessment period which is both formal and informal to ascertain whether we are able to meet all their needs and that they are happy with the choice of home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans generally are detailed and show staff how to meet individuals needs. However improvements should be made to ensure that care plans reflect peoples current needs. Evidence: We looked at five peoples care records. On the whole care plans seen were of a good quality and detailed how staff were to meet peoples needs. They included assessments for areas of risk and actions staff needed to take to minimise these. All of the care plans had been recently reviewed and as and when peoples needs had changed. Short term care plans were seen to be implemented when people had urine infections or other short term needs. Some shortfalls were found in care records: Two of the people being casetracked had food or fluid monitoring charts in place. Some were incomplete or the total fluid intake had not been totalled. Care Homes for Older People Page 13 of 29 Evidence: The care plans for two people stated that they were to be weighed weekly. One had not been weighed for over a month and the other last weighed three weeks previously. Records stated that the weighing chair was broken. This has been fixed and the frequency of recording peoples weights has been reviewed according to their assessed need. One person had a care plan in place for monitoring their skin condition, which stated that the body map was to be reviewed weekly but there was no body map completed. Another care plan gave instructions for one person to receive hourly checks and position changes every two hours throughout the night. Charts evidenced that position changes varied between two and four hourly. Two cream charts were found to not be fully completed and signed by staff. Risk assessments had been completed for each person relating to identified areas of risk and need. The daily care records for people seen, were mainly task focused and did not always reflect how people were always spending their time at the home. The Register Provider advised that there are plans to further improve care records so that these give a more accurate reflection of individuals day to day lives and rather than the care and support they receive. Appropriate medical attention or advice had been sought for people when necessary. It was evident that GPs, district nurses and specialist assessors, such as for speech and language, had visited the home and seen people. Service user records included a personal profile which gave good information on their life history. The medication and records for the people being casetracked were seen and this was seen to be well managed. No gaps were seen and medications prescribed as needed (PRN) documented why and when they were to be given. One persons file contained a letter from the GP authorising the covert administration of medication and reasons why. The home completes a risk assessment for any individual who self medicates and Care Homes for Older People Page 14 of 29 Evidence: ensures that this is reflected within their care plan. Staff were observed to be kind and caring in their interactions with people during the course of the day. One person needed encouragement to take their medication and asked for some juice to help with this. Staff assisted with this and showed patience and gentleness. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are assisted to participate in activities appropriate to their needs and given choices to maintain their quality of life. Consideration should be given to reducing the length of time some people wait for assistance at mealtimes, to make mealtimes more pleasurable for them. Evidence: An activities co ordinator is employed to work at the home part time but planned to become full time in the following month. There is a programme of activities available to people and one to one sessions held with others who had higher levels of needs, such as being bedbound or increasingly confused. On the day of the visit the hairdresser was in and the activities co ordinator was observed sitting talking to people and painting nails. During discussion she told us that she is currently getting to know each resident and focusing on accommodating their individual needs and preferences. A small shop is available in the home selling personal items, the library service visit Care Homes for Older People Page 16 of 29 Evidence: and provide books and clergy members are also welcomed at the home. People appeared calm and relaxed on all units within the home and there were some sensory activities and soft toys available for people who had a more advanced stage of dementia. Staff were observed interacting kindly and in a caring manner with people during the course of the day and explaining what was happening in an appropriate way. People appeared to enjoy their food and were assisted as needed. However it was observed that mealtimes can be particularly busy on units with people who require higher levels of assistance and some people had to wait for help to eat, as staff were busy assisting others. People spoken to said the food was ok. The AQAA said that the homes internal annual quality assurance indicated that 73 percentage of respondents felt that they could get a drink or something to eat when they wanted, with no-one expressing an opposite view. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their concerns will be listened to and acted upon. All staff should receive regular updates in safeguarding training to ensure that people living there are properly protected from the risk of harm or neglect. Evidence: The home has a formal complaints policy which is accessible to people and their families. People and relatives spoken with told us that they know how to make a complaint. We looked at the complaint records kept at the home. There have been four complaints received in the last year. There were records of the complaint investigations, the outcomes and the actions taken to reduce any recurrances, however some of these were not clearly recorded. However it is acknowledged that these were documented under a previous manager and the new manager discussed how he would more accurately record them. The registered provider informed us that staff receive training in the Protection of Vulnerable Adults (POVA) as part of their induction, and that it is company policy for staff to receive updates every two years. This is so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. However at the time of inspection some staff had not yet received an update in this Care Homes for Older People Page 18 of 29 Evidence: area. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained and furnished so that people live in a relaxed, homely and comfortable environment. Evidence: The home is divided into four separate units three of which are for individuals who have dementia. Each unit has its own dining area and lounge with facilities for the making of refreshments and snacks. The bathroom and bedroom doors are colour coded to assist people with dementia to easily identify different areas. Low surface radiators have been fitted throughout the home to reduce the risks of burns. We looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. The rooms were personalised with their own belongings. There was hand wash and paper towels in the communal toilets and bathrooms and pedal bins used in the bathrooms. The laundry was well organised and clean and tidy, with adequate well working equipment for the size of the home. Care Homes for Older People Page 20 of 29 Evidence: Systems are in place to reduce the risk of infection. Disposable gloves and aprons are available and used by staff when handling soiled linen and when supporting people with personal care. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are monitored to ensure peoples needs are met and recruitment procedures are well met. All staff should receive regular updates in mandatory training to ensure that staff are able to safely undertake their role. Evidence: On the day of the visit there were 48 people living at the home. The staffing rotas showed that there are 10 care staff on duty for both the morning and the afternoon shift. In addition to this there is also a senior carer, a care team manager, management, activity, catering and domestic staff. Staff spoken with in one area of the home said that generally they felt there were adequate staffing levels but sometimes they felt quite stretched on areas where several residents had higher needs, such as hoisting. Staff also commented though that they felt staffing had improved since Nick Holman had become manager and they felt confident with his management skills. The AQAA submitted by the home said Staffing levels and rosters are reviewed on a regular basis. Shift times of the senior team have been altered to improve and provide sufficient cover of staffing at critical care times. Care Homes for Older People Page 22 of 29 Evidence: Three staff files were looked at including some of the most recently recruited staff members. All of them contained the required documentation including a criminal records bureau (CRB) check and a POVA (protection of vulnerable adults) check. The training matrix for the home showed that not all staff were up to date with several areas of mandatory training, including safeguarding vulnerable adults. This was discussed with the manager who acknowledged that he was aware of this since recently coming into post and was starting to address it by booking training dates. A number of staff had received dementia awareness training and training records showed that staff complete an induction programme. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in an improving home. Residents and others are able to express their views and these are listened to and acted upon. Evidence: Nick Holman is the registered manager. He is an experienced manager and has begun to review and improve practice throughout the home. Staff meetings had already been held to discuss issues within the home and staff spoken with said they felt well supported by the new manager and were confident improvements were being made. There is a quality assurance system in place, including clinical audits, monthly monitoring of accidents and incidents. Surveys and regulation 26 visits are also undertaken. The AQAA was also completed by the manager and submitted prior to inspection. Care Homes for Older People Page 24 of 29 Evidence: The home hold monies for some residents at the home and three of these records were randomly checked and found to be well managed. Information provided in the AQAA show that relevant health and safety checks and maintenance are being carried out at the home. A number of health and safety records were checked, including the fire safety log and showed that generally these were well managed. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 The registered provider must 31/05/2010 ensure that staff receive training appropriate to the work they perform. It is important that staff receive the training they need to keep up to date with good practice and ensure the safety of the people living in the home. Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 Care and support monitoring 31/03/2010 records must be completed and regularly reviewed. Action must be taken when changes occur in peoples health needs and records reviewed and amended accordingly. This is to make sure that peoples health and well being is monitored and they receive the care and support they need. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Daily records should be further improved to ensure that these give a more accurate reflection of peoples day to day lives rather than the care and support provided to them. Sufficient staff should be available to assist people who need help at mealtimes. This is to ensure that some people do not have to wait whilst others are being assisted and their pleasure and dignity is maintained. Page 27 of 29 2 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 18 All staff should receive regular updates in safeguarding training to ensure that people living there are properly protected from the risk of harm or neglect. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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